Department of Medicine, Roswell Park Cancer Institute, Buffalo, N.Y., USA.
Oncology. 2012;82(1):41-7. doi: 10.1159/000333855. Epub 2012 Jan 26.
The objective of this study was to determine the rate of salvage resections in patients with stage II and III colorectal cancer following intensive surveillance in a comprehensive cancer center.
Patients with stage II and III colorectal cancer with a minimum follow-up of 3 years were included. Carcinoembryonic antigen was obtained every 3 months for 2 years and then every 6 months for years 3-5. CT scans of the chest, abdomen and pelvis were performed every 6 months for 2 years and then yearly for years 3-5. Colonoscopy was performed at year 1 and then every 3 years.
One hundred and seventy-seven patients were followed for a median of 60 months; 44 patients were diagnosed with recurrent disease. CT was the first sign of recurrence in 68% of patients. Carcinoembryonic antigen test was normal in 20 patients (45%) at the time of disease recurrence. Twenty-five patients (57%) with recurrent disease underwent curative-intent resection, 12 of whom are still cancer free at a median follow-up of 81 months.
In this retrospective study, intensive radiographic screening was associated with a high salvage resection rate, which led to favorable clinical outcomes. Randomized clinical trials are urgently needed to define the optimal duration and schedule of radiographic screening in stage II and III colorectal cancer.
本研究旨在确定在综合癌症中心进行强化监测后，II 期和 III 期结直肠癌患者进行挽救性切除术的比率。
纳入至少随访 3 年的 II 期和 III 期结直肠癌患者。在最初的 2 年内，每 3 个月检测一次癌胚抗原，然后在第 3 至 5 年期间每 6 个月检测一次。在最初的 2 年内，每 6 个月进行一次胸部、腹部和骨盆的 CT 扫描，然后在第 3 至 5 年期间每年进行一次。在第 1 年进行结肠镜检查，然后每 3 年进行一次。
177 例患者的中位随访时间为 60 个月；44 例患者被诊断为疾病复发。在 68%的患者中，CT 是复发的第一个迹象。在疾病复发时，20 例患者（45%）癌胚抗原检测正常。25 例（57%）复发患者接受了根治性切除术，其中 12 例在中位随访 81 个月时仍无癌症。
在这项回顾性研究中，强化影像学筛查与高挽救性切除术率相关，这导致了良好的临床结果。迫切需要进行随机临床试验来确定 II 期和 III 期结直肠癌影像学筛查的最佳持续时间和方案。
